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Linear immunoglobulin A bullous dermatosis (LABD) is a rare autoimmune blistering skin disease characterized by deposition of IgA autoantibodies along the basement membrane zone (BMZ). Although LABD is most often idiopathic, it can be triggered by infections and drugs, or occur in association with other autoimmune diseases, lymphoproliferative disorders and internal malignancies. Acquired hemophilia A (AHA) is a rare and potentially life- threatening coagulation deficiency caused by the production of anti-factor VIII autoantibodies. Similarly to LABD, it has been associated with malignancies, drugs, or other autoimmune diseases. A 57-year-old male patient presented with sudden onset of pruritic vesicles and bullae distributed on the upper trunk, proximal extremities, axillary vaults and inguinal folds. Lesions were partially distributed in herpetiform fashion, resembling “cluster of jewels” or in annular and polycyclic arrangement creating the “string of beads sign”. There were also multiple erosions and vesicles on the oral mucosa and bilateral conjunctivitis. Histopathological findings of lesional skin showed subepidermal blister and a dermal infiltrate rich in neutrophils and eosinophils. Direct immunofluorescence analysis showed linear deposits of IgG and IgA, and focal granular deposits of C3 along the BMZ. Indirect immunofluorescence, ELISA for IgG antibodies against BP 180, Desmoglein 1 and 3, ANA and ENA screen were all negative. A diagnosis of LABD was made, and based on the patient history of recent introduction of perindopril, moxonidine and amlodipine, it was presumed to be drug-induced. A relatively rapid remission was achieved within a month, after discontinuation of the incriminated drugs and a course of systemic glucocorticoids. However, as the erosions healed, the patient developed melena and widespread suffusions, accompanied by tingling sensation and pain. Laboratory analyses revealed significantly prolonged activated partial thromboplastin time, a decrease of factor VIII activity and the presence of factor VIII inhibitors, findings indicative of AHA. Neither a combination of glucocorticoids and cyclophosphamide, nor intravenous immunoglobulin therapy demonstrated sufficient clinical response. Clinical and laboratory remission was finally achieved with rituximab. The coincidence of autoimmune bullous diseases and AHA is very rare, and to the best of our knowledge, this is the second reported case of AHA occurring in association with LABD. References: 1. Makita S et al. Acquired hemophilia associated with autoimmune bullous diseases: a report of two cases and a review of the literature. Intern Med. 2013 ; 52(7):807-10. 2. Arakaki O et al. Case of linear immunoglobulin A bullous dermatosis associated with acquired hemophilia. J Dermatol 2008 ; 35(7):437-46. 3. Filipczak A et al. Coexistence of pemphigus foliaceus and acquired hemophilia A: A case report. J Dermatol 2015 ; 42(6):638-41. 4. Qiu X et al. Acquired hemophilia associated with bullous pemphigoid: a case report. Int J Clin Exp Pathol 2012 ; 5(1):102-4.

Recent data suggest that childhood and adulthood stressors may play a significant role in the development of an autoimmune disease. The present study explores the relationship between psoriatic arthritis (PsA) and positive and negative life events during childhood and adulthood in psoriatic patients. Forty-five patients with psoriatic arthritis and 101 controls (patients with skin conditions considered to be "non-psychosomatic") were enrolled in the study. All participants completed a specific questionnaire measuring traumatic life experiences [Traumatic Antecedents Questionnaire (TAQ)]. The TAQ assesses positive personal experiences (competence and safety) and negative personal experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas and exposure to alcohol/drugs) from early childhood to adulthood. The patients with psoriatic arthritis exhibited lower mean scores of total positive experiences during late childhood (latency) as compared to the control group. Negative experiences during four developmental periods appeared more frequently in patients with psoriatic arthritis than in the controls. The most frequently reported negative experiences were neglect, emotional abuse, physical abuse, sexual abuse, alcohol/drug abuse and other traumas. The present findings add evidence to the relationship between retrospectively reported childhood experiences and psoriatic arthritis. Furthermore, a high amount of reported emotional and physical abuse occurs in patients with psoriatic arthritis during latency and adolescence.

It is well known that several psychiatric disorders may be related to childhood psychological trauma. Recent studies have associated childhood exposure to trauma to some skin diseases. Our study aimed at exploring whether psoriasis is related to the reported positive and negative traumatic life events in different age intervals beginning from early childhood to adulthood. Furthermore, we investigated differences between psoriatics with early and late onset according to traumatic experiences in different age intervals. Also, we investigated the possible correlation of traumatic experiences with the disease severity. One hundred patients with psoriasis and 101 controls (patients with skin conditions considered to be "non-psychosomatic") were enrolled in the study. All participants completed a specific questionnaire measuring traumatic life experiences (Traumatic Antecedents Questionnaire, TAQ). The TAQ assesses positive personal experiences (competence and safety) and negative personal experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas and exposure to alcohol/drugs) from early childhood to adulthood. The severity of psoriasis was estimated according to the Psoriasis Area and Severity Index (PASI), a standardized measuring instrument. The amount of positive experiences did not differ significantly among groups, except for safety scores that were higher in controls compared with both psoriatic groups (early and late onset). On the other side, negative traumatic experiences appeared more frequently in patients with psoriasis during all developmental periods. We found no correlation between severity of psoriasis and traumatic experiences. The present study demonstrates an increased history of childhood and adulthood negative traumatic experiences in patients with psoriasis compared to the control group. Our findings suggest a relationship between retrospectively reported negative traumatic experiences and psoriasis.

Psoriasis is a chronic papulosquamous skin disease, histologically characterized by epidermal hyperproliferation and dermal infiltration of inflammatory cells. The majority of T lymphocytes infiltrating dermis are CD4+ T lymphocytes secreting type 1 and type 17 cytokines. These cytokines are responsible for triggering keratinocyte proliferation as well as chemokine secretion and subsequent migration of other inflammatory cells in the skin. Contrarily, lymphocytes that accumulate in epidermis are mainly CD8+ T lymphocytes. According to the recent findings, these cells can also secrete type 1 and type 17 cytokines. However, it is demonstrated so far that epidermal CD8+ T lymphocytes contain higher amounts of cytolytic molecules, such as perforin, granzyme B and granulysin whose role in psoriasis pathogenesis is still unknown. Therefore, in this article we hypothesize the active involvement of cell mediated cytotoxicity in killing the proliferating keratinocytes as a mechanism of potential self-defense and possible brake in psoriatic plaque formation, maintaining skin homeostasis.

Hrvatsko dermatovenerološko društvo Hrvatskoga liječničkog zbora ustrojilo je radnu skupinu vodećih hrvatskih stručnjaka koji se bave psorijazom. Radna je skupina kritički proučila mjerodavnu znanstvenu literaturu te donijela smjernice za dijagnostiku i liječenje psorijaze., Croatian dermatovenerological society of the Croatian Medical Association formed the working group which consists of leading experts for psoriasis in Croatia. After a critical analysis of relevant scientific papers, the working group has developed guidelines for the diagnosis and treatment of psoriasis

Alopecia areata (AA) is a frequent disease with nonscarring hair loss on the scalp and/or body. Hair follicle in alopecia areata is not irreversibly destroyed, so potential for hair regrowth remains. Considering unknown etiopathogenesis, treatment of AA is symptomatic and directed toward halting disease activity. Lymphocytic inflammatory infiltrate around hair follicle, increased levels of autoantibodies, cytokine abnormalities and increased prevalence of autoimmune comorbidities, support the hypothesis of AA as an organ-specific autoimmune disorder. Therefore, investigations are directed toward new immunomodulatory or immunosuppressive drugs with induction effect on hair growth. New biologic drugs and their influence on hair growth as well as genetic therapy for alopecia areata are currently under investigation. Contemporary principles in therapy of alopecia areata and treatments available will be discussed in this article.

Cilj: Danas važeća teorija svrstava psorijazu u psihokutane psihofiziološke bolesti. Traumatska iskustva u djetinjstvu povezuju se s pojavom artritisa i nekih kožnih bolesti te se smatra da u kombinaciji s genetskim faktorima predstavljaju rizične faktore za pojavu psorijaze i psorijatičnog artritisa. Prikaz slučaja: Psorijaza i psorijatični artritis su imunološki posredovane bolesti, a rana traumatska iskustva uzrok su poremećene kompetencije imunološkog sustava s regulatornim problemima u sustavima koji reguliraju odgovor na psihički stres. U radu je prikazana bolesnica sa psorijazom i psorijatičnim artritisom koja je od najranijeg djetinjstva bila izložena mnogobrojnim negativnim traumama u djetinjstvu. Rasprava: Emocionalno zanemarivanje, alkoholizam oca, izostanak osjećaja sigurnosti i kompetentnosti tijekom djetinjstva doveli su do negativnih i bolnih emocija sa stvaranjem obrasca za rasterećenje koji ide putem kože, odnosno zglobova. Dinamika obiteljskih odnosa diktirala je uvelike i tijek njene bolesti i načine nošenja s teškoćama koje je bolest donosila. Uobičajene ili standardne metode liječenja nisu dale zadovoljavajuće rezultate, no interdisciplinarnim pristupom i dugotrajnim psihoterapijskim liječenjem postignuti su značajni i dugoročni terapijskih rezultati. Tijekom psihoterapijskog liječenja razmatrani su njeni disfunkcionalni obrasci ponašanja i razlozi za njih. Bolesnica je u grupi dobila emocionalnu podršku, proradila dio svojih ranijih iskustava i uspjela ojačati ego snage za nošenje sa svakodnevnim obavezama i relacijama. Njen promijenjen odnos prema sebi i okolini omogućio joj je da gratifikaciju nađe u svojoj okolini i relaciji s bliskim osobama iz svog okruženja. Zaključak: Samo kombinirana i individualno prilagođena terapija, uz psihoterapijski pristup, može dovesti do dugotrajnijeg uspjeha u liječenju ovih bolesti, Aim: According to the new classification of psycho-dermatological disorders, psoriasis is classified as a psychophysiological disease. Recent studies have associated childhood exposure to trauma to same skin and joint diseases. Traumatic experiences in childhood combined with genetic predisposition are considered to be important risk factors in the development of psoriasis and psoriatic arthritis. Case report: Psoriasis and psoriatic arthritis are immunologically triggered diseases and early traumatic experiences are the reason of altered competence of the immune system with the regulatory problems in systems that control the response to psychologic stress. We showed a female patient with psoriasis and psoriatic arthritis with increased childhood negative traumatic experiences. Discussion: Emotional neglect, alcoholism of the father, the lack of sense of security and competence during childhood led to negative and painful emotions with creating a pattern of discharge that leads through the skin and joints. The dinamics of family relations formed in an important manner the ongoing of the disease and the ways of dealing with the difficulties that the desease caused.The common or standardized methods for treating of psoriasis and psoriatic arthritis that have been used since the beginning of the treatment, did not show satisfactory results. However, interdisciplinary approach and longterm pshichotherapy resulted in significant and lasting positve treatment results. During a psychotherapy the disfunctional patterns of behaviour and their reasons were analysed. The patient received emotional support of the group, she worked through a part of her former experiences and succeded in improving her ego for the strength for coping with the everyday dutys and relations. The changed relationship for herself and the surrounding enabled her to find thankfulness in her milieu and the relationship with close people from her surroundings. Conclusion: Thus, only a combined and individually adjusted therapy, together with a psychoterapic approach can lead to a long lasting success in treating this deseases.

Alopecija areata (AA) česta je bolest koja se očituje neožiljnim gubitkom dlake na vlasištu i/ili tijelu. Folikul dlake u alopeciji areati nije nepovratno uništen, stoga potencijal za ponovni rast kose ostaje. Budući da je etiopatogeneza nepoznata, liječenje AA je simptomatsko i usmjereno na zaustavljanje aktivnosti bolesti. Limfociti oko dlačnog folikula, povišena razina autoprotutijela, poremećaj citokina te udruženost s drugim autoimunosnim bolestima, podupiru hipotezu da je AA organ-specifična autoimunosna bolest. Nova su istraživanja stoga usmjerena na razvoj lijekova koji bi imunomodulatornim ili imunosupresivnim djelovanjem potaknuli rast dlake. Proučavanje utjecaja novih bioloških lijekova na rast kose, kao i razvoj genske terapije u tijeku su. U radu će biti raspravljeni suvremeni principi i dostupne metode liječenja alopecije areate., Alopecia areata (AA) is a frequent disease with nonscarring hair loss on the scalp and/or body. Hair follicle in alopecia areata is not irreversibly destroyed, so potential for hair regrowth remains. Considering unknown etiopathogenesis, treatment of AA is symptomatic and directed toward halting disease activity. Lymphocytic inflammatory infiltrate around hair follicle, increased levels of autoantibodies, cytokine abnormalities and increased prevalence of autoimmune comorbidities, support the hypothesis of AA as an organ-specific autoimmune disorder. Therefore, investigations are directed toward new immunomodulatory or immunosupresive drugs with induction effect on hair growth. New biologic drugs and their influence on hair growth as well as genetic therapy for alopecia areata are currently under investigation. Contemporary principles in therapy of alopecia areata and treatments available will be discussed in this article.

Alopecija areata neožiljni je upalni gubitak dlake na vlasištu i/ili tijelu, nepoznate etiopatogeneze. Najčešće zahvaćeno mjesto je vlasište. Histopatologija se očituje povećanim brojem katagenih i telogenih folikula te nazočnošću upalnog limfocitnog infiltrata u peribulbarnoj regiji. U liječenju alopecije areate najčešće se primjenjuju kortikosteroidi. U radu je opisana klinička i patohistološka slika uz suvremene metode liječenja alopecije areate., Alopecia areata is a nonscarring, inflammatory hair loss on the scalp, and/or body. Etiology and pathogenesis are still unknown. The most common affected site is the scalp. Histopathology is characterized by an increased number of the catagen and telogen follicles along with the presence of inflammatory lymphocytic infiltrate in the peribulbar region. Corticosteroids are the most popular drugs for the treatment of this disease. Clinical features, histological data as well as modern treatment options will be discussed in this article.

A 76 year old female patient presented with multiple erythematous itchy patches on her face and neck along with hair loss, scaling and inflammation in the occipital region of the scalp that had started 2 months ago. Therapy with local corticosteroid creams were recommended. Direct microscopy of scraping specimens from skin lesions and scalp were positive for fungal hyphae. The patient was successfully treated with oral itraconazol and for 3 months and 1 % clotrimazole cream.

An open, noncomparative study was performed to establish the efficacy of azithromycin in the treatment of early syphilis. Sixteen patients were treated with oral azithromycin: 1g the first day and then 500 mg for the following 8 days. Two patients were excluded from the study, leaving 14 patients for the evaluation of the efficacy. Venereal Disease Research Laboratory (VDRL) negativity was observed in 3 out of 6 patients treated for primary syphilis after 3 months and in all patients after 6 months. Two of 8 patients treated for manifest or early latent secondary syphilis had VDRL negativity after 3 months and 4 patients after 6 months. This study demonstrates that azithromycin is effective in the treatment of early syphilis. Two patients experienced gastrointestinal side effects which did not require treatment interruption.

The corresponding author of the manuscript was inadvertently omitted the author name Marija Kastelan from the author group of the published article. The revised author group is given below.